Download Section: 2-1

Geriatrics – Assessment of Vision in Older Adults
Strength of Evidence Level: 1
PURPOSE:
To assess the vision function of the older adult in the
home environment.
CONSIDERATIONS:
1. Glaucoma is one of the leading causes of blindness.
2. Diabetic retinopathy: Diabetes is the leading cause
of new blindness among adults and people with
diabetes.
3. Age-related macular degeneration (AMD) is a
leading cause of vision loss in people 65 years or
older in the United States.
4. By age 65 years, 1 in 3 Americans has some form
of vision-impairing eye disease.
5. The Snellen chart tests distance. Other screening
tools include Rosenbaum or Jaeger cards which test
near sightedness.
6. If no screening tools are available have patient read
a few lines from a newspaper. If a patient can read
both the headline and a sentence of the smallest
print, there is normal visual acuity. If only the
headline is read there is moderate impairment and
there is severe impairment if neither can be read.
7. Older persons with visual impairment are twice as
likely to have difficulties performing ADL's and
IADL's.
8. Changes in vision affect quality of life, mental
health, life satisfaction and involvement in home and
community activities.
9. Persons with visual impairments will have difficulty
reading prescription labels and handling personal
finances.
10. Aging is associated with an increased prevalence of
visual impairment.
11. Seniors age 65 years and older should have
complete eye exams by their eye doctor every 1 to 2
years to check for cataracts, glaucoma, age-related
macular degeneration, diabetic retinopathy and
other eye conditions.
12. Referral to a physician should be made if the patient
exhibits the following:
a. Takes certain medications.
b. Has had a serious eye injury in the past.
c. Is African American (because of the increased
risk of glaucoma).
d. Has a personal or family history of eye disease.
e. Squinting or blinking more than usual.
f. Sensitive to light or glare.
g. Eyelids or eyes have changed in appearance.
h. Eye twitches.
i. Bumping into or tripping over things, moving
hesitantly, or walking close to the walls.
j. Holds things close to his/her eyes to see them.
k. Has trouble distinguishing faces or reading
signs.
l. Wears clothes that are mismatched or stained.
SECTION: 21.04
__RN__LPN/LVN__HHA
EQUIPMENT:
Snellen chart
Scissors
Tape
Pencil
Yardstick
Flashlight
10-foot long space
Well-lit room
Paper cup or 4x4
PROCEDURE:
1. Explain the procedure to the patient.
2. Measure 10 feet from a wall with no windows and
place a chair at this point.
3. Tape the chart on the bare wall, level with the
patient's eyes.
4. Have the patient stand or sit, depending where the
chart is positioned.
5. Cover right eye with the paper cup or 4x4. (If patient
wears glasses, they should be worn during the test.)
6. Shine the flashlight on each line of the chart while
the patient reads the letters out loud.
7. Continue to the bottom row or until the patient is
unable to read the letters.
8. Record the number of the smallest line seen with
the majority of the letters correctly identified.
9. Repeat the test with the left eye covered and record
the results.
10. Adult should be reading the 20/20 line. If there are
abnormal results, a medical eye examination should
occur for results by an ophthalmologist.
AFTER CARE:
1. Record results of the screening exam.
2. Notify physician as needed.
3. Refer patient to ophthalmologist as needed.
REFERENCES:
University of Nebraska Medical Center. Department of
Internal Medicine. Geriatrics. GERI Pearls. Functional
Disability Screening. Retrieved July 26, 2010, from
http://webmedia.unmc.edu/intmed/geriatrics/reynolds/pe
arlcards/functionaldisability/vision_evaluation.htm
EyecareAmerica. The foundation of the American
Academy of Ophthalmology. Home Eye Test. Retrieved
July 26, 2010, from
http://www.eyecareamerica.org/eyecare/tmp/Home-EyeTest.cfm
Prevent Blindness. (n.d.). Prevent Blindness America
the vision learning center. Retrieved from
http://www.preventblindness.org/eye_tests/near_vision_r
ecom.html